Overview of procurement of Immunization Devices including ... · Overview of procurement of Immunization Devices including forecasting process and ... (21 mio) and C (2 mio). •

Overview of procurement of

Immunization Devices including

forecasting process and

accuracy

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• The overall procurement strategy is to ensure an uninterrupted sustainable supply of affordable quality products.

• UNICEF has played the role of a market shaper for AD syringes and remains one of the world’s largest buyers of AD syringes: around 504 million syringes for over 80 countries in 2012.

UNICEF Supply Does Make a Difference…

UNICEF forecasted AD Syringes and Safety boxes market share (2013 - 90 countries)

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64%

36%

SD Others

Safety Boxes excluding India

69%

31%

SD Others

AD Syringes excluding India

Injection Safety

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Objective - Prevent reuse of syringes which may have resulted in number of cases of HIV (260,000), Hepatitis B (21 mio) and C (2 mio).

• No harm to the recipient

• No harm to the health-care worker

• No harm to the community

Reuse of equipment

Unsafe collection

Unsafe

disposal

What is Injection Safety?

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Safe Disposal of Injection Equipment and Other Sharps in Safety boxes – the first level of waste management

•Prevents needle sticks • Disposed off immediately in leak-proof, puncture-proof containers such as needle-disposal boxes, sharps containers, or safety boxes.

Too Full - Unsafe

3/4 Full - Safe

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Guiding elements, QA and management

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Driving Elements for the Management and Procurement of Devices

• WHO/UNFPA/UNICEF Joint Policy on Injection Safety

All countries should by 2003 use only Auto-Disable (AD) syringes for immunization injections, (1999)

• Bundling Policy From a forecasting, funding and planning perspective,

ensure availability of sufficient numbers of AD syringes, reconstitution syringes and Safety boxes for each vaccine dose.

Number of AD syringes = (number of vaccine doses – wastage)*1.1 Number of reconstitution syringes = (number of vials)*1.1 Number of safety boxes = ((number of AD’s + reconstitution syringes)/100)*1.1

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• WHO PQS Pre-qualification is a mandatory criteria to be eligible for an award in UNICEF

• WHO obtains feed back on UNICEF supplies and WHO provides technical guidance to UNICEF

• UNICEF SD Quality Assurance Centre is responsible for sample review and also testing and inspections on supplies as well as complaints handling.

• All awards for immunization devices are subject to a successful plant inspection undertaken by Quality Assurance Centre.

• Each awarded product must have gone through a successful user friendly field trial (applicable for AD syringes)

WHO Standard (PQS) Forms The Core Guide supplemented with QAC controls

Management and Procurement

• Annual forecasting process for > 90 countries (routine, supplementary, stock-levels/stock outs, funding sources, procurement channels and shipment plans), including RUP (2008)

• Use of multi year Long Terms Arrangements with several suppliers as a result of an international competitive tendering process.

• Allocation sheets to ensure global availability and timely delivery

• Working towards introducing new products to countries

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The current market

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AD syringe Supply and Management

• The market has moved from an almost monopoly situation to a healthy market with several stakeholders including in developing countries

• > 50% price reduction (current WAP <4.5 cents a piece) – bulk procurement, economy of scale, product development and increased competition

• Reduced risk of re-use

• Product development - From larger to smaller products, using less material, less waste, optimising freight and lower prices – an overall more sustainable and environmental friendly supply

• Annual turnover: USD 22.8 million (2012)

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Safety Box Supply and Management

• Increased competition including product

development

• Price is heavily dependent on the paper

and pulp market

• Increased number of suppliers, however remains

limited.

• Annual turnover: USD 9.7 million (2012)

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Current Long Term Arrangement period 2011-2013 and price range

• 5 LTA’s for 0.5 ml AD syringes

• Price range between: 3.92 cents – 4.65 cents per syringe

• 2 LTA’s for 0.05ml BCG syringes

• Price range between: 5.29 – 5.50 cents per syringe

• 2 LTA’s for 5L safety boxes

• Price range between: USD 0.488 – 0.580 per box

• Detailed prices could be found on UNICEF website: http://www.unicef.org/supply/files/Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf

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http://www.unicef.org/supply/files/Auto-disable_AD_syringes_and_Safety_Boxes_price_data.pdf





Demand and price development

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After the peak, 2005-2007 the demand is back at levels of 2002 and 2004, with a weighted average price below 4.5 cents

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$0.000

$0.010

$0.020

$0.030

$0.040

$0.050

$0.060

$0.070

$0.080

0

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000

600,000,000

700,000,000

800,000,000

900,000,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Quantity in pieces Price per piece (USD)

India

Price sensitivity due to EURO/USD and volatile paper and pulp industry (safety box procurement 2000-2012)

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$0.000

$0.100

$0.200

$0.300

$0.400

$0.500

$0.600

$0.700

$0.800

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Quantity in pieces Price per piece (USD)

Peru

Funding

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GAVI remains the main funding source for UNICEF SD procurement of AD syringes

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$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

PROG PS GAVI

GAVI together with Procurement Service partners are the main funders of UNICEF SD procurement for Safety Boxes

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$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

PROG PS GAVI

The main procurement service customers are governments for AD syringes

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$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

GVT $2,252,752 $773,453 $3,981,025 $1,615,067 $1,270,710 $5,565,814$25,089,101$6,510,414 $6,785,706 $3,992,330 $5,830,426 $4,563,023 $4,158,190

ISS - Immunization Strengthening Support $3,593,891

JICA $899,275 $577,109 $159,077 $487,771 $505,322 $134,390 $9,205 $60,099 $64,415 $29,452

World Bank $953,358 $192,077 $493,348 $153,838 $222,517 $1,182,384

PATH $687,230 $192,139

EU Sahel Initiative $191,672 $215,971 $132,225 $65,961

KfW (Kreditanstalt fur Wiedereafbau) $379,566 $75,613 $104,148

Gates Foundation $269,910

SACB - Somalia Aid $102,839 $122,762

UN Organizations $3,152 $0 $35,648 $8,051 $45 $56,658 $1,122 $36 $9,706 $7,076 $14,793 $22,239 $23,829

Pakistan Basket Funding $12,670 $9,033

Vishnevskaya-Rostropovich Foundation $46,157 $69,656 $10,944 $9,365

GAVI $80,869 $19,950 $7 $19,572 $2,686

Rotary International $3,168 $2,487 $13,514

Others $26 $62,915 $12,863 $96,172 $12,469 $0 $28,450 $0 $18,662 $82,890 $54,900 $0 $0

Governments are the dominating procurement service customers for Safety Boxes

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$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

GVT $21,36 $58,70 $326,1 $214,2 $134,9 $737,7 $732,6 $475,0 $743,5 $1,106 $1,598 $487,7 $2,094

ISS - Immunization Strengthening Support $328,2

JICA $62,10 $45,42 $30,42 $104,9 $58,82 $9,978 $790 $2,447 $289 $3,955

Global Fund $19,16 $71 $11,68 $92,88 $31,94 $70,80 $71,05

World Bank $79,36 $3,517 $16,19 $70,23 $5,075 $12,50 $33

Pakistan Basket Funding $123,6

UN organizations $337 $0 $2,046 $810 $0 $8,139 $872 $10,85 $0 $33,72 $3,515 $2,488 $2,860

Others $6,180 $33,51 $48,42 $23,89 $16,08 $27,90 $23,29 $73 $1,932 $2,777 $21,46 $331 $14

Main destinations for supply

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More than 70% of the AD syringes are for the African continent (2008-2012)

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3.1% 8.1%

29.3%

6.6% 8.8% 1%

43.2%

CEE/CIS EAPRO ESARO MENA ROSA TACRO WCARO

UNICEF Safety boxes procurement is more fragmented (2008-2012)

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3.8% 5.9%

25%

6.5% 7.2%

19%

32.6%

CEE/CIS EAPRO ESARO MENA ROSA TACRO WCARO

Forecast process

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Immunization devices are forecasted in the same way as vaccines

Annual forecast exercise covering a 5 year period • First year split on a month by month basis • Remaining years as an annual quantity • Covers routine and supplementary activities Country Driven Process • Primary Source of Country Data • Standardized format of data capture, known software • Data capture for evaluation purposes SD Evaluates Country Forecast against: • Country Specific Data provided in the forecast; Partner programmatic information;

prior history • Forecast Accuracy; Historical procurement figures and Current orders Review and Clarification process • Overviews generated by product • Reviewed for peak demand periods, funding shortfalls, adjustments made Quantities are issued to industry 27

Sample of the Forecasting tool - Identifying needs -

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Ro

uti

ne

Su

pp

lem

en

tary

Corresponding needs for devices

Stock Data

Forecasting tool – Identifying quantities to be procured and funding sources -

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Forecasting tool – Shipments plan -

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Ship

me

nt

Pla

n f

or

de

vice

s

Forecast accuracy

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AD syringes Awarded vs Actual Procurement

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2008 2009 2010 2011 2012

82.63%

66.33%

96.84%

85.50% 83.68%

Awarded Actual Procurement

BCG syringes Awarded vs Actual Procurement

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2008 2009 2010 2011 2012

73.56%

80.85%

90.54%

83.14% 80.24%

Awarded Actual Procurement

Safety boxes Awarded vs Actual

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0%

20%

40%

60%

80%

100%

120%

140%

2008 2009 2010 2011 2012

92.11% 96.06%

138.82%

89.62%

125.67%

Awarded Actual off take

Multiple causes for Variances in demand

• Slow uptake of new vaccines and therefore related immunization devices

• Competing programmes/priorities • Delay or lack of Funding - (e.g. large campaigns) • Independent (un-forecasted) activities • Outbreaks and emergency response • Political factors (country preferences) • Etc, etc ………

• Continuous dialogue with countries, programmes and suppliers is critical

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Enhanced Injection Safety

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Additional Injection Safety Elements

• 2005 - Reduce risk of re-use - UNICEF preference for AD syringes with a location of the disabling mechanism commencing prior to injection of the full fixed dose

• 2006 - Program instruction on RUP syringes – Enhanced Injection Safety targeting 2ml, 5ml and 10 ml syringes destined for reconstitution of vaccines with a built in safety mechanism preventing re-use

• 2008 - Enhanced Injection Safety – LTA in place for Re-use prevention featured syringes (RUP), so far around 50 million pcs for 21 countries (2012) and a price below the WAP price for AD syringes (2013).

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THANK YOU

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UNICEF REGIONAL CLASSIFICATION

Eastern and Southern Africa Eastern and Southern Africa Regional Office (ESARO) Angola, Botswana, Burundi, Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, Somalia, South Africa, South Sudan, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe West and Central Africa West and Central Africa Regional Office (WCARO) Benin, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Sao Tome and Principe, Senegal, Sierra Leone, Togo Middle East and North Africa Middle East and North Africa Regional Office (MENARO) Algeria, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, State of Palestinian, Oman, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen Central and Eastern Europe and the Commonwealth of Independent States Central and Eastern Europe and the Commonwealth of Independent States Regional Office (CEE/CIS) Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kosovo, Kyrgyzstan, Montenegro, Republic of Moldova, Romania, Russian Federation, Serbia, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan

South Asia

Regional Office for South Asia (ROSA)

Afghanistan, Bangladesh, Bhutan, Federal Democratic Republic of Nepal, India, Maldives,

Pakistan, Sri Lanka

East Asia and the Pacific*

East Asia and Pacific Regional Office (EAPRO)

Brunei Darussalam, Cambodia, China, Cook Islands, Democratic People’s Republic of Korea,

Indonesia, Kiribati, Lao People’s Democratic Republic, Malaysia, Marshall Islands, Micronesia

(Federated States of), Mongolia, Myanmar, Nauru, Niue, Palau, Papua New Guinea, Philippines,

Republic of Fiji, Republic of Korea, Samoa, Singapore, Solomon Islands, Thailand, Timor-Leste,

Tonga, Tuvalu, Vanuatu, Viet Nam

Latin America and the Caribbean*

Latin America and the Caribbean Regional Office (TACRO**)

Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of),

Brazil, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador,

Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama,

Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname,

Trinidad and Tobago, Uruguay, Venezuela (Bolivarian Republic of)

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Documents

Overview of procurement of Immunization Devices including ... · Overview of procurement of Immunization Devices including forecasting process and ... (21 mio) and C (2 mio). •